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Complications during central venous access device removal in children: A systematic review and meta-analysis

Mahesh Sakthivel1, Danesh Sakthivel2, Ramesh M Nataraja3

  • 1Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia.

Journal of Pediatric Surgery
|July 7, 2025
PubMed

Insights

Complications during central venous access device (CVAD) removal in children are linked to longer indwelling times and acute lymphoblastic leukemia (ALL) diagnosis. Further research is needed to prevent these mechanical issues.

Area of Science:

  • Pediatric oncology
  • Medical devices
  • Interventional radiology

Background:

  • Mechanical complications during central venous access device (CVAD) removal, such as adherence or fragmentation, pose risks to pediatric patients.
  • Identifying incidence and risk factors for these complications is crucial for improving patient safety.

Purpose of the Study:

  • To determine the incidence of complications during CVAD removal in children.
  • To identify risk factors associated with these complications.

Main Methods:

  • A systematic review adhering to PRISMA guidelines was conducted from 1970 to 2024.
  • Eleven retrospective studies involving 4019 CVAD removals were analyzed using a random effects model for meta-analysis.
  • Study quality was assessed using the ROBINS-I tool.

Main Results:

  • The overall incidence of CVAD removal complications in children was 5.6%, with significant heterogeneity observed.
  • Key risk factors identified for overall complications included indwelling time >2 years, acute lymphoblastic leukemia (ALL) diagnosis, and polyurethane catheters.
  • Specific risk factors for retained catheters included longer indwelling time and ALL diagnosis.

Conclusions:

  • Longer indwelling times (>2 years) and ALL diagnosis are significant risk factors for complicated pediatric CVAD removal.
  • Other potential risk factors include catheter material, younger age at insertion, and smaller lumen size.
  • Further large-scale prospective studies are recommended to validate these findings and inform preventative strategies.
Abstract

Keywords:
Central venous access deviceCentral venous catheterComplicationsPediatricsRemoval

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